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A combination regimen comprising three therapeutic modalities: **transarterial chemoembolization (TACE)**, **immune checkpoint inhibitor (ICI)**, and a **vascular endothelial growth factor (VEGF) inhibitor**. This combination is used primarily in advanced cancers such as unresectable hepatocellular carcinoma (HCC). TACE is a loco-regional procedure designed to induce tumor necrosis and stimulate local immune responses by blocking arterial blood supply to the tumor, leading to the release of tumor antigens. ICIs, most commonly PD-1/PD-L1 inhibitors, block immune checkpoint pathways on T cells to restore antitumor immunity. VEGF inhibitors block angiogenesis needed for tumor growth, either through monoclonal antibodies (e.g., bevacizumab) or small-molecule tyrosine kinase inhibitors (TKIs) targeting VEGF receptors (e.g., lenvatinib, sorafenib). The rationale is that TACE-induced tumor necrosis increases tumor antigen availability, VEGF inhibition suppresses angiogenesis and immunosuppression, and ICIs potentiate antitumor immune responses, generating a synergistic effect. Data suggest enhanced response rates, though impact on overall survival and progression-free survival versus double or monotherapy is mixed and under active clinical investigation[3][5][7].
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